Kidney transplant outcomes associated with the use of increased risk donors in children

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Abstract

Increased risk donors (IRDs) may inadvertently transmit blood-borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. We used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants that were performed in the United States between January 1, 2005 and December 31, 2015. We used the Cox regression analysis to compare patient and graft survival between IRD and non-IRD recipients, and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. We studied 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4% to 13.2%. IRDs were more likely to be male (P =.04), black (P <.001), and die from head trauma (P =.006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P =.02). After multivariate adjustment, patient survival after IRD transplants was significantly higher compared with remaining on the waitlist (adjusted hazard ratio [aHR]: 0.48, 95% CI: 0.26-0.88, P =.018); however, patient (aHR: 0.93, 95% CI: 0.54-1.59, P =.79) and graft survival (aHR: 0.89, 95% CI: 0.70-1.13, P =.32) were similar between IRD and non-IRD recipients. We recommend that IRDs be considered for transplant in children.

Original languageEnglish (US)
Pages (from-to)1684-1692
Number of pages9
JournalAmerican Journal of Transplantation
Volume19
Issue number6
DOIs
StatePublished - Jun 1 2019

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Tissue Donors
Transplants
Kidney
Graft Survival
Survival
Craniocerebral Trauma
Registries
Regression Analysis
Pediatrics
Viruses

Keywords

  • clinical research / practice
  • donors and donation: deceased
  • donors and donation: donor-derived infections
  • kidney transplantation / nephrology

PubMed: MeSH publication types

  • Journal Article

Cite this

@article{334521e12add44d8af5b026adb12d03d,
title = "Kidney transplant outcomes associated with the use of increased risk donors in children",
abstract = "Increased risk donors (IRDs) may inadvertently transmit blood-borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. We used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants that were performed in the United States between January 1, 2005 and December 31, 2015. We used the Cox regression analysis to compare patient and graft survival between IRD and non-IRD recipients, and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. We studied 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4{\%} to 13.2{\%}. IRDs were more likely to be male (P =.04), black (P <.001), and die from head trauma (P =.006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P =.02). After multivariate adjustment, patient survival after IRD transplants was significantly higher compared with remaining on the waitlist (adjusted hazard ratio [aHR]: 0.48, 95{\%} CI: 0.26-0.88, P =.018); however, patient (aHR: 0.93, 95{\%} CI: 0.54-1.59, P =.79) and graft survival (aHR: 0.89, 95{\%} CI: 0.70-1.13, P =.32) were similar between IRD and non-IRD recipients. We recommend that IRDs be considered for transplant in children.",
keywords = "clinical research / practice, donors and donation: deceased, donors and donation: donor-derived infections, kidney transplantation / nephrology",
author = "Kizilbash, {Sarah J} and Rheault, {Michelle N} and Qi Wang and Vock, {David M} and Srinath Chinnakotla and Pruett, {Timothy L} and Chavers, {Blanche M}",
year = "2019",
month = "6",
day = "1",
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language = "English (US)",
volume = "19",
pages = "1684--1692",
journal = "American Journal of Transplantation",
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T1 - Kidney transplant outcomes associated with the use of increased risk donors in children

AU - Kizilbash, Sarah J

AU - Rheault, Michelle N

AU - Wang, Qi

AU - Vock, David M

AU - Chinnakotla, Srinath

AU - Pruett, Timothy L

AU - Chavers, Blanche M

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Increased risk donors (IRDs) may inadvertently transmit blood-borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. We used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants that were performed in the United States between January 1, 2005 and December 31, 2015. We used the Cox regression analysis to compare patient and graft survival between IRD and non-IRD recipients, and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. We studied 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4% to 13.2%. IRDs were more likely to be male (P =.04), black (P <.001), and die from head trauma (P =.006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P =.02). After multivariate adjustment, patient survival after IRD transplants was significantly higher compared with remaining on the waitlist (adjusted hazard ratio [aHR]: 0.48, 95% CI: 0.26-0.88, P =.018); however, patient (aHR: 0.93, 95% CI: 0.54-1.59, P =.79) and graft survival (aHR: 0.89, 95% CI: 0.70-1.13, P =.32) were similar between IRD and non-IRD recipients. We recommend that IRDs be considered for transplant in children.

AB - Increased risk donors (IRDs) may inadvertently transmit blood-borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. We used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants that were performed in the United States between January 1, 2005 and December 31, 2015. We used the Cox regression analysis to compare patient and graft survival between IRD and non-IRD recipients, and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. We studied 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4% to 13.2%. IRDs were more likely to be male (P =.04), black (P <.001), and die from head trauma (P =.006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P =.02). After multivariate adjustment, patient survival after IRD transplants was significantly higher compared with remaining on the waitlist (adjusted hazard ratio [aHR]: 0.48, 95% CI: 0.26-0.88, P =.018); however, patient (aHR: 0.93, 95% CI: 0.54-1.59, P =.79) and graft survival (aHR: 0.89, 95% CI: 0.70-1.13, P =.32) were similar between IRD and non-IRD recipients. We recommend that IRDs be considered for transplant in children.

KW - clinical research / practice

KW - donors and donation: deceased

KW - donors and donation: donor-derived infections

KW - kidney transplantation / nephrology

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EP - 1692

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 6

ER -